Site-to-site variation in the factors affecting cesarean section rates
W. J. Hueston
St Claire Medical Center, Morehead, Ky, USA.
OBJECTIVE: To investigate the influence of various factors, including
physician specialty, on the risk of cesarean birth. DESIGN: Retrospective
medical chart review. PARTICIPANTS: Review of 7367 deliveries at five
hospitals in five different states. MAIN OUTCOME MEASURE: Method of
delivery. RESULTS: Logistic regression modeling using clinical and
demographic risk factors found that the risk factors that influence
cesarean delivery varied considerably among different hospitals. Only
primiparity (relative risk, 2.22 to 5.81 among sites) and multiple
gestation (relative risk, 4.74 to 100.48 depending on the site) were
associated with increased cesarean delivery in all sites. Private
insurance, preeclampsia, and having an obstetrician as the primary medical
provider were also independently associated with cesarean delivery in four
sites. Examination of 50 other variables showed no consistent independent
associations with cesarean delivery. CONCLUSIONS: The clinical and
nonclinical factors that influence cesarean section are highly site
dependent. This implies that physicians practicing at different sites are
influenced by different criteria when deciding whether a cesarean delivery
should be performed.
